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Elaine Welteroth: Using Midwifery Care Was the Best Decision I Ever Made

Just as I sat down to write this, a woman died during childbirth at a hospital in Los Angeles The city where I also live and gave birth nine months ago. Her name was April Valentine. She was a Black woman, like me. I don’t know much about her, but I don’t need to know the details of her story to know that she could have been me.

When I learned about the severity of the Black maternal mortality crisis in this country, I was already very pregnant and searching for a doctor that would make me feel safe and seen in the face of my fears about becoming another statistic.

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Like most American women, I set out to have a hospital birth—just as my mother had done. It wasn’t so much a choice as it was the default. Almost everything I knew about childbirth had been programmed by Hollywood’s frenzied depictions of screaming women being hauled, legs up, through fluorescent hospital halls. As scary as it all seemed, hospital births are the norm in America. Apparently, so is birth trauma. Unlike most obstetricians, midwives are trained to focus on the whole person, recognizing a healthy pregnancy includes both physical and mental health. Midwives are licensed, certified medical practitioners and experts in low-risk pregnancies, which make up the vast majority of pregnancies in the U.S. Pushing for increasing accessibility to midwifery care in America is essential to women’s health and is at the core of why I am sharing my story.

I was shocked to learn that the U.S. sustains the highest maternal death rate of any high-income nation—a rate that’s climbed by 30% in the past 15 years—all while the global maternal mortality rates have decreased in other developed nations. This disproportionately affects Black families and mothers—who are three times more likely to die. Unfortunately, data shows that the U.S. midwifery workforce is far behind globally as compared to other wealthy, developed nations. There are only four midwives per 1,000 births in the U.S., while many European countries have five to 10 times that.

Here’s the part I can’t live with: According to the CDC 84% of these deaths are preventable. When you hear statistics like that, you feel either hopeless or motivated to help change them.

If you think these statistics don’t apply because of your economic or social status, you’d be gravely mistaken. It doesn’t matter how educated, wealthy, or connected you are—this crisis affects women in all communities in the U.S. As Charles Johnson, a maternal care activist and father of two, who lost his wife due to medical neglect after a cesarean section, puts it: “you either are a mom or have a mom. This crisis impacts everyone in some way.”

But it doesn’t have to be this way. Studies show that including midwives in the healthcare system could prevent more than 80% of maternal and infant deaths. In places like the U.K., midwives deliver more than half of babies born and their maternal mortality rate is more than three times lower than the U.S. As I went through my own research ahead of giving birth I wondered why we don’t hear more about midwifery care.

The midwifery care model provides longer prenatal visits, the option to birth out of the hospital, the ability to move freely during labor and to deliver in whatever position is most advantageous for the baby and the birthing person. In the hospital, most birthing people deliver on their backs (about 68% according to 2020 research by BMC Pregnancy and Childbirth) to the advantage of the hospital systems that are operating in a for-profit model.

Even as I was awakened to the beauty and logical benefits of the out-of-hospital birth model, if I’m honest, I still didn’t see myself as the “kind” of mom who would opt for one. There are these stereotypical tropes about the women who choose to have home births…the woo-woo, crystal-slanging, anti-formula, granola mom cult. That isn’t me. That is part of why midwifery somehow still seemed too fringe, too unorthodox, too risky. As it turns out, that’s by design. In the early 1900s, successful smear campaigns against community birth workers were weaponized when male-supervised obstetrics was introduced and male physicians replaced midwives. These campaigns were designed for political persuasion and to achieve legal reform.

Because of this conditioning, there was still a voice in my head saying that a hospital delivery with the right doctor would feel safer. But finding the “right” doctor proved harder than I imagined. And it isn’t because skilled, caring doctors don’t exist. It’s because they work within a for-profit system that is set up to protect its own interest—time and money. The hospital system is created to serve as many people as possible, as quickly as possible. Even if a doctor wants to, in many cases they can’t give you the time, care and individualized attention you may need in your most vulnerable state.

The first doctor I visited, when I was two months pregnant, hardly made eye contact with me as she pinged me with sensitive health questions, typing answers into a keypad without looking up. After 6 vials of my blood were mistakenly drawn from my arm without apology (pure negligence), a different doctor kicked me out of her examination room after 15 minutes because I had exceeded their “two question visit max.” I went from doctor to doctor, only to leave each appointment dejected and disappointed to the point of tears more times than I can count. I felt like a product on a conveyor belt and my spirit couldn’t take it anymore.

But whether my birth plan was ready or not, this baby was on its way and the journalist in me refused to give up. I didn’t want to just survive childbirth–I wanted to thrive. So, I decided to educate myself and my community in real-time by interviewing birth workers like midwife maverick Jennie Joseph, one of Time’s Women of The Year, in a live series I started called MaterniTea. Exploring all of my options in a supportive space unlocked a sense of empowerment; advocating for myself meant advocating for my baby–and for other moms feeling just as lost.

After much deliberation, in my 36th week of pregnancy, I took my biggest leap of faith and decided to pursue a home birth under the care of Black midwives at Kindred Space LA—the only birthing center in Los Angeles owned by Black women. Over tea in Kindred’s gardens and through hours spent at my bedside during prenatal appointments, my midwife and co-owner of the space, Kimberly Durdin, nurtured a sense of self-trust that carried me through the safe and sacred birth of our 9-pound baby boy. Pivoting to midwifery care was the best decision I’ve ever made. When I was in my most vulnerable state, midwives cared for more than my body–they took care of my spirit, my mind, and my family’s too.

I want to be very clear that I have absolutely no interest in perpetuating mommy wars of any kind. For God’s sake, how could I? I’m the mom who had a home birth and then started combo feeding with formula on day two of my baby’s life—I’m not even sure what “side” would claim me because I certainly don’t fit neatly into either box. And that’s the whole point. Neither do any of us. It’s time to do away with the tropes and the stigmas so that more birthing people can stay alive to parent the babies we bring into this world.

Pivoting to midwifery care was life-changing for me—but I am well aware that it’s still considered a privilege in this country. This same choice should be readily accessible for every birthing person—whether they are delivering at home, in a birthing center, or in a hospital setting. And that’s exactly what this movement is fighting for.

By reframing this issue through the lens of hope, possibility, and collaboration, I believe we can improve outcomes. That’s why I’m telling my story. I hope it serves as a reminder that motherhood journeys are not monolithic and self advocacy is a huge piece of this problem-solving puzzle. The default model is driving deadly outcomes and nothing will change if we don’t tell our stories to shift the narrative and fight for greater access to information and resources that make alternatives more accessible.

At scale, addressing the system failures requires a multi-prong approach: legislative change, more equity in access to community birth workers both at home and in hospitals–which includes insurance companies supporting alternative birthing options–more resources for grassroots organizations, and more companies in the parenting space putting their resources behind this issue.

You can’t champion women without championing their right to a safe birthing experience—especially at a time when some Americans are losing the ability to determine when and if we become parents. The same system forcing people into parenthood should be held responsible for keeping them alive.

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